Wednesday, November 28, 2018

HHS Issues Comprehensive Draft Report with Eyes on Reducing Health IT Burden - Healthcare Informatics

Required by the Cures Act, the strategy lays out core issues and challenges related to health IT burden, while offering several recommendations

The Department of Health and Human Services (HHS) has issued a federal draft strategy designed to help reduce administrative and regulatory burden on clinicians caused by technology such as electronic health records (EHRs).

The draft strategy, which is 74 pages, was developed by the health IT arm of the federal government—the Office of the National Coordinator for Health Information Technology (ONC)—in partnership with the Centers for Medicare & Medicaid Services (CMS), and was required in the 21st Century Cures Act.

According to federal health IT officials, “The draft strategy reflects the input and feedback received by ONC and CMS from stakeholders, including clinicians, expressing concerns that EHR burden negatively affects the end user and ultimately the care delivery experience. This draft strategy includes recommendations that will allow physicians and other clinicians to provide effective care to their patients with a renewed sense of satisfaction for them and their patients.”

Based on the input received by ONC and CMS, the draft strategy outlines three overarching goals designed to reduce clinician burden:

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1. Reduce the effort and time required to record health information in EHRs for clinicians;

2. Reduce the effort and time required to meet regulatory reporting requirements for clinicians, hospitals, and health care organizations; and

3. Improve the functionality and intuitiveness (ease of use) of EHRs.

Officials noted in the announcement today that healthcare stakeholders have indicated to ONC and CMS that when they use their EHRs, clinicians have to rely on checkboxes, templates, cut-and-paste functions, and other workarounds that hinder the intended benefits of EHRs. Clinicians have reported they are spending more time entering data into the EHR, leaving less time to interact with their patients. Required documentation guidelines have led to “note bloat,” making it harder to find relevant patient information and effectively coordinate a patient’s care.

According to ONC officials in a blog post accompanying the draft strategy today, “By releasing this draft strategy, we are taking one more step toward improving the interoperability and usability of health information by establishing a goal, strategy, and recommendations to reduce regulatory and administrative burdens relating to the use of EHRs.” But, they added, “We can’t do this alone. The Cures Act, and a thorough analysis of the drivers of burden, require that the government and industry work together to reduce the burden of using EHRs.”

Throughout the last few years, ONC and CMS have undoubtedly made burden reduction a top priority in their respective agencies. ONC even created a position in 2017— deputy assistant secretary for health technology reform—that would specifically focus on burden reduction, tapping John Fleming, M.D., a former Congressman and a practicing family physician to fill the role.

Meanwhile, CMS, in the last several months, has overhauled the  Medicare and  Medicaid Promoting  Interoperability  Program  (formerly known as the EHR Incentive Programs) and has proposed to overhaul the Merit-based Incentive Payment System (MIPS) Promoting Interoperability performance category (formerly known as the Advancing Care Information performance category) to focus on interoperability, improve flexibility, and relieve burden.

In notable comments today from Donald Rucker, M.D., National Coordinator for Health IT, he said, “We look forward to advancing the premise of how to accurately model and support the clinical cognitive process in the EHR—a shift away from a strictly linear, logic-based model to a more sophisticated design that supports the complex pattern recognition inherent in the diagnostic and treatment process.”

Rucker added more details in his comments: “New healthcare-specific software design elements will help produce software tailored to the clinical workflow. We envision a time when clinicians will use the medical record not as an encounter-based document to support billing, but rather as a tool to fulfill its original intention: supporting the best possible care for the patient….Similarly, quality  reporting should be seamless, accessible  through  the metadata  in  the  EHR, and  available  through high-quality,  clinically mature application programming interfaces (APIs), which will reduce the need to separately submit data.”

The Cures Act, signed into law in December 2016, requires HHS to articulate a plan of action to reduce regulatory and administrative burden relating to the use of health IT and EHRs. Specifically, the Cures Act directs HHS to: establish a goal for burden reduction relating to the use of EHRs; develop a strategy for meeting that goal; and develop recommendations to meet the goal.

For this draft report, HHS reviewed stakeholder input and established four workgroups which included representatives from across HHS, including ONC, CMS, and other federal offices.  Each of these workgroups focused on a different aspect of EHR-related burden, specifically: clinical documentation; health IT usability and the user experience; EHR reporting; and public health reporting.

For each of these aspects, the report lays out what the core issues and challenges are, while then outlining an array of strategies and recommendations for improvement.

In a statement, HHS Secretary Alex Azar said, “Usable, interoperable health IT was one of the first elements of the vision I laid out earlier this year for transforming our health system into one that pays for value. With the significant growth in EHRs comes frustration caused, in many cases, by regulatory and administrative requirements stacked on top of one another. Addressing the challenge of health IT burden and making EHRs useful for patients and providers, as the solutions in this draft report aim to do, will help pave the way for value-based transformation.”

Added Seema Verma, CMS Administrator, “Over the past year, we hosted listening sessions, received written feedback, and heard from a wide range of clinical stakeholders about the current health IT systems and the requirements specifying documentation, reimbursement, and quality reporting that are burdensome and should be re-examined.” 

The public comment period on the draft strategy is open until January 28, 2019.



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